Hurricane Ike slams Texas coast and tests hospice emergency plans

Agencies pleased with response, but identified needed improvements

Winds that exceeded 80 miles per hour, storm surges that covered major streets, and power outages that lasted more than a week for many people were just a few of the effects of Hurricane Ike. The good news for Texas hospice and home health organizations is that their emergency plans worked well.

"Our patients were in the areas that were under evacuation orders," says Wyona Freysteinson, RN, MS, director of the home health and hospice at Memorial Hermann Hospital in Houston. In addition to working with patients to be sure that the hospice knows where they are going and how to contact them, Freysteinson's staff calls hospices in the destination area to arrange for care while they are evacuated. They use lists they've developed over the years through direct contact or through local associations. "This is a key component of our evacuation plan," she says. "There are other hospices in the Houston area that told their patients who were evacuating to go the hospital in their destination area if they needed care," Freysteinson says.

As soon as the reports showed that Ike would be a severe storm, hospice staff began calling patients and verified that they all had seven to 10 days of medication, says Freysteinson. If the patient needed additional medication, it was delivered, she says. "Prior to the storm, we made sure that any patients who needed transportation during an emergency were included on the county's 2-1-1 list to make sure they would be evacuated," she says.

Staff members at Lakes Area Hospice in Jasper, TX, also made sure that patients were included on the county's 2-1-1 list, but they discovered that their understanding of the 2-1-1 service differed from reality. "We got to test the system when Hurricane Gustav threatened our area," says Paula Moore, volunteer coordinator of the agency. Although Gustav's path veered away from Jasper, Moore learned that the 2-1-1 system was set up to transport people from central pick-up locations rather than pick people up from their homes.

"The county did not have the budget to pay for transportation to all 300 homes of home health and hospice patients on the 2-1-1 system and had decided to have people meet at the local high school or other central location," Moore explains. Unfortunately, people registered with 2-1-1 because they had no driver's license, no car, and no other caregiver who could drive them, she says. Only one week passed between Gustav and Ike, so the county had to improvise, she says.

"I'm in awe of the county workers who used their vehicles to go to all 300 homes to pick up patients," says Moore. "This was not the most efficient use of their time because they had other evacuation-related responsibilities, but they put the safety of patients first," she says. Review of the 2-1-1 plan and ideas to improve it are under way, she says.

Moore believes that her agency was able to implement its plans quickly because she was in touch with county emergency management as a result of her involvement in the monthly emergency management meetings. "There have been many months when I wondered why I was spending my time at these meetings, but the information I received, the contacts I made, and ideas I heard, all helped my hospice be better prepared," she says.

Hurricanes cause crises in many areas

Even hospices and home health agency staff members who were away from the coast and outside Texas found themselves facing emergencies related to Ike.

"We have an emergency plan in place, but the damage from the winds that was a result of Hurricane Ike was completely unexpected," says Dorean Levenberg, RN, administrator of Deaconess Home Care in Cincinnati. Power outages were the biggest problem caused by the wind as trees fell on power lines throughout the area, she says. "We had one person who had gone in to the office on Sunday to finish up some paperwork, and she called to tell me that there was no power at the office," she says. "I never would have known that we had a problem if she had not called."

Because Levenberg had the warning that there were power outages that could affect her agency, she and other managers showed up early at the office to start calling employees. "We found that our power had been restored overnight, but there were many staff members and patients without power," she says. Staff members without power at their homes came into the office to charge cell phones and laptops, and staff members who had power at their homes operated as usual.

Power outages weren't a problem in the Southeast, but staff members at Visiting Nurse Health Service in Atlanta had to deal with a different effect of Hurricane Ike. Because Georgia and several other Southeastern states receive gasoline through pipelines from the Texas coast, gasoline supplies in some areas were reduced as a result of pipeline shutdowns. "We heard from a staff member who called the office to report that she had a hard time finding a gas station with gasoline before the Atlanta media began reporting the problem," says Mary Zagajeski, RN, MS, COS-C, vice president of home health operations for the agency. Communications with staff members was the key to making sure that clinicians were able to visit all patients, she adds.

Whatever emergency your agency experiences, be sure to recognize staff efforts once everything is back to normal, Freysteinson suggests. "We've held parties at each office, luncheons at some, and breakfasts at others, depending on what fits their normal schedule for meetings," she says. Awards such as a crossword puzzle book for the staff member who sat the longest in the gas line and a flashlight for the staff member who was without power the longest were awarded at each office. "This was a scary experience with winds and trees crashing into homes," she says. "It is important to set aside time to say that we're glad to be alive."

Need More Information?

For more information about emergency preparedness, contact:

  • Wyona Freysteinson, RN, MN, Director of Memorial Hermann Home Health and Hospice, 16538 Air Center Blvd., Houston, TX 77032. Telephone: (800) 259-1002 or (281) 784-7520. E-mail:
  • Dorean Levenberg, RN, Administrator, Deaconess Home Care, 1008 Marshall Ave., Suite A, Cincinnati, OH 45225. Telephone: (800) 559-4757 or (513) 281-1430. Fax: (513) 281-1409. E-mail:
  • Paula Moore, Volunteer Coordinator, Lakes Area Hospice, 254 Ethel St., Jasper, GA 75951. Telephone: (409) 384-5995. E-mail:
  • Mary Zagajeski, MS, RN, COS-C, Vice President, Home Health Operations, Visiting Nurse Health System, 6610 Bay Circle, Suite C, Norcross, GA 30071. Telephone: (770) 936-1041. E-mail:
  • The 2-1-1 Initiative is a partnership between United Way of American and the Alliance of Information and Referral Systems to provide an easy way for people to access community programs and services in their area. About 76% of the U.S. population is served by a 2-1-1 program. For more information on the initiative, go to and select "2-1-1 initiative" on the top navigational bar.